Critical Care Case Studies

Critical Care Case Studies-78
Small studies, including case series and controlled trials, have evaluated the efficacy of intrapulmonary thrombolysis [21-23].

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Success in achieving hemodynamic stability and improvement in ventricular wall function was higher in dogs receiving infusions of norepinephrine.

The effect is hypothesized to be due to increased systemic pressures, resulting in improved coronary perfusion and improved right ventricular function.

In cases of massive pulmonary embolism, what options remain when systemic thrombolysis cannot be performed safely?

Surgical embolectomy involves transection of the main pulmonary artery via sternotomy incision with manual extraction of thromboembolism.

The trachea was urgently intubated and heparin was discontinued.

Interventional radiology was consulted for catheter thrombectomy and inferior vena caval (IVC) filter placement.

Historically, surgical embolectomy was the only available option for patients who fail or who have contraindications to systemic thrombolysis.

It is not clear what role it will play in the future given the advent of other interventional options (listed below).

Therefore, caution must be exercised in extrapolating the results of these small studies to patients with contraindications to systemic thrombolysis or anticoagulation.

Further investigation into the safety of this technique in high risk patient populations is needed.

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